[Congressional Record Volume 143, Number 66 (Monday, May 19, 1997)]
[Senate]
[Pages S4686-S4687]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   PARTIAL-BIRTH ABORTION--THE TRUTH

 Mr. ABRAHAM. Mr. President, I would like to submit the 
following testimony for the Record. Dr. Curtis Cook is a board-
certified obstetrician/gynecologist and a subspecialist in maternal-
fetal medicine in Michigan. In March, Dr. Cook testified before the 
House-Senate joint hearing on ``Partial-Birth Abortion--The Truth.'' 
His expert testimony speaks to both the medical necessity of the 
partial-birth procedure and the issue of fetal pain during the 
procedure.
  The testimony follows:

 Testimony by Curtis Cook, M.D., Maternal Fetal Medicine, Butterworth 
           Hospital, Michigan State College of Human Medicine

       My name is Dr. Curtis Cook. I am a board-certified 
     Obstetrician/Gynecologist and a subspecialist in Maternal-
     Fetal Medicine (also known as Perinatology or High Risk 
     Obstetrics). In my practice I take care of referred 
     complicated pregnancies because of preexisting chronic 
     medical conditions of the mother, or suspected abnormalities 
     in the baby. I am also the Associate Director of our region's 
     Maternal-Fetal Medicine division and also serve as Assistant 
     Residency Director for our Obstetrics and Gynecology training 
     program, I am an Assistant Clinical Professor at Michigan 
     State University of College of Human Medicine, and a member 
     of the American College of OB/GYN, The Society of Perinatal 
     Obstetricians, The American Medical Association, and the 
     Association of Professors of Gynecology and Obstetrics. I am 
     a founding member of PHACT (Physicians Ad Hoc Coalition for 
     Truth about Partial Birth Abortion), which I helped organize 
     after hearing the appalling medical misinformation circulated 
     in the media regarding this procedure. PHACT includes in its 
     membership over 400 physicians from Obstetrics, Maternal-
     Fetal Medicine and Pediatrics. Many of these physicians are 
     educators or heads of departments, and also include the 
     former Surgeon General, C. Everett Koop. All that in required 
     of a physician for membership in an Interest in maternal and 
     child health, and a desire to educate the population on this 
     single issue.
       I must begin my statement by defining partial birth 
     abortion as the feet first delivery of a living infant up to 
     the level of its after coming head, before puncturing the 
     base of its skull with a sharp instrument and sucking out the 
     brain contents, thereby killing it and allowing the collapse 
     of its skull and subsequent delivery. This description is 
     based upon the technique of Dr. Haskell of Ohio, who has 
     subsequently identified it as accurate. He has referred to 
     his technique as

[[Page S4687]]

     ``D & X'' (Dilatation and Extraction), while Dr. McMahon of 
     California refers to it as an ``intact D & E.'' An ACOG ad 
     hoc committee came up with the hybrid term ``intact D & X''. 
     As you can see, many terms are used and are not clear in 
     their description.
       Partial birth abortion is mostly performed in the fifth and 
     six months of pregnancy. However, these procedures have been 
     performed up to the ninth month of pregnancy. The majority of 
     patients undergoing this procedure do not have significant 
     medical problems. In Dr. McMahon's series, less than ten 
     percent were performed for maternal indications, and these 
     included some ill-defined reasons such as depression, 
     hyperemesis, drug exposed spouse, and youth. Many of the 
     patients undergoing partial birth abortion are not even 
     carrying babies with abnormalities. In Dr. McMahon's series, 
     only about half of the babies were considered ``flawed'', and 
     these included some easily correctable conditions like cleft 
     lip and ventricular septal defect. Dr. Haskell claimed that 
     eighty percent of his procedures were purely elective, and a 
     group of New Jersey physicians claimed that only a minuscule 
     amount of their procedures were done for genetic 
     abnormalities or other defects. Most were performed on women 
     of lower age, education, or socioeconomic status who either 
     delayed or discovered late their unwanted pregnancies. It is 
     also clear that this procedure occurs thousands of times a 
     year, rather than a few hundred times a year, as claimed by 
     pro-abortion advocates. This has been independently confirmed 
     by the investigative work of The Washington Post, The New 
     Jersey Bergen Record and the American Medical Association 
     News.
       One of the often ignored aspects of this procedure is that 
     it requires three days to accomplish. Before performing the 
     actual delivery, there is a two day period of cervical 
     dilation that involves forcing up to twenty five dilators 
     into the cervix at one time. This can cause great cramping 
     and nausea for the women, who are then sent to their home or 
     to a hotel room overnight while their cervix dilates. After 
     returning to the clinic, their bag of water is broken, the 
     baby is forced into a feet first position by grasping the 
     legs and pulling it down through the cervix and into the 
     vagina. This form of internal rotation, or version, is a 
     technique largely abandoned in modern obstetrics because of 
     the unacceptable risk associated with it. These techniques 
     place the women at greater risk for both immediate (bleeding) 
     and delayed (infection) complications. In fact, there may 
     also be longer repercussions of cervical manipulation leading 
     to an inherent weakness of the cervix and the inability to 
     carry pregnancies to term. We have already seen women who 
     have had trouble maintaining pregnancies after undergoing a 
     partial birth abortion.
       There is no record of these procedures in any medical text, 
     journals, or on-line medical service. There is no known 
     quality assurance, credentialling, or other standard 
     assessment usually associated with newly-described surgical 
     techniques. Neither the CDC nor the Alan Gultmacher Institute 
     have any data on partial birth abortion, and certainly no 
     basis upon which to state the claim that it is a safer or 
     even a preferred procedure.
       The bigger question then remains: Why ever do a partial 
     birth abortion? There are and always have been safer 
     techniques for partial birth abortion since it was first 
     described by Dr. McMahon in 1989 and Dr. Haskell in 1992. The 
     usual and customary (and previously studied) method of 
     delivery at this gestation is the medical induction of 
     labor using either intravaginal or intramuscular 
     medications to cause contractions and expulsion of the 
     baby. This takes about twelve hours on average, and may 
     also include possible cervical preparation with the use of 
     one to three cervical dilators (as opposed to the three-
     day partial birth abortion procedure, with up to 25 
     dilators in the cervix at one time). This also results in 
     an intact baby for pathologic evaluation, without 
     involving the other risk of internally turning the baby or 
     forcing a large number of dilators into the cervix. The 
     only possible ``advantage'' of partial birth abortion, if 
     you can call it that, is that it guarantees a dead baby at 
     time of delivery.
       The less common situation of partial birth abortion 
     involves, an abnormal baby. These conditions do not threaten 
     a woman over and above a normal pregnancy, and do not require 
     the killing of the baby to preserve her health or future 
     fertility. I have taken care of many such women with the same 
     diagnoses as the women who provided testimony on this issue 
     in the past. Each of these women stated that they needed to 
     have a partial birth abortion performed in order to protect 
     their health or future fertility. In these cases of trisomy 
     (extra chromosomal material), hydrocephaly (water on the 
     brain), polyhydramnios (too much amniotic fluid) and 
     arthrogryposis (stiffened baby), there are alternatives to 
     partial birth abortion that do not threaten a woman's ability 
     to bear children in the future. I have personally cared for 
     many cases of all of these disorders, and have never required 
     any technique like partial birth abortion in order to 
     accomplish delivery. Additionally, I have never had a 
     colleague that I have known to have used the technique of 
     partial birth abortion in order to accomplish delivery in 
     this same group of patients. Moreover, there are high profile 
     providers of third trimester abortions who likewise do not 
     use the technique of partial birth abortion.
       In the even rarer case of a severe maternal medical 
     condition requiring early delivery, partial birth abortion is 
     not preferred, and medical induction suffices without 
     threatening future fertility. Again, the killing of the fetus 
     is not required, only separation from the mother.
       Finally, I wish to address the fetal pain issue, since it 
     has been claimed that a fetus feels no pain at these 
     gestational ages. This is about as ridiculous as the earlier 
     claim that the anesthesia of partial birth abortion put the 
     baby into a medical coma and killed it prior to the 
     performance of the auctioning technique. This was no small 
     claim to the many pregnant women undergoing non-obstetric 
     surgery every day in this country. Fortunately, this was 
     soundly denounced by both the American Society of 
     Anesthesiologists and the Society of Obstetrical Anesthesia 
     and Perinatology. In the course of my practice, we must 
     occasionally perform life-saving procedures on babies while 
     still in the uterus, I have often observed babies of five to 
     six months gestation withdraw from needles and instruments, 
     much like a pain response. Dr. Fisk in England has recently 
     reported an increase in fetal pain response hormones during 
     the course of these procedures at these same gestational 
     ages. In addition, we frequently observe the standard 
     grimaces and withdrawals of neonates born at six months 
     gestation like any other pain response in a more mature 
     infant.
       While it is not my desire for legislators to enter into the 
     realm of medical policy making, there are times when the 
     public health risk needs to be addressed if the medical 
     community is either unwilling or unable to address it. We 
     have seen this precedent for female circumcision and forty-
     eight hour postpartum stays. I believe the unnecessary, 
     unstudied, and potentially dangerous procedure of partial 
     birth abortion is unworthy of continuance in modern 
     obstetrics. It neither protects the life, the health or the 
     future fertility of women, and certainly does not benefit the 
     baby. For these reasons, I urge you to support the ban on 
     partial birth abortion.
       I thank you for the opportunity to share my testimony and 
     my concern for the women and children of this 
     country.

                          ____________________